FAQ's

 

ModivCare maintains a Facility Services Department dedicated to handling the non-emergency medical transportation needs of medical practitioners that serve Nassau and Suffolk County fee-for-service (FFS) Medicaid enrollees who have no other way to get a ride, and who may need a single trip or regularly reoccurring standing order transport. For example, transport three days each week to and from dialysis. A dedicated Facility Services Department staff and phone and fax numbers are available to book transportation needs received from these medical practitioners by phone, fax or online on behalf of the enrollees they serve.  The phone number is 844-678-1106.  The fax number is: 855-848-8640.  

Thus medical practitioners can arrange transport for enrollees by phone, fax or online.  You will find instructions and forms for arranging non-emergency medical transportation included on this web site and/or in the answers below.

Every 3 months our Facility Services Department will fax or call the medical practitioner to re-certify the standing order and enrollee information.  Facilities must respond to ModivCare's recertification request in order to be able to continue to:

  • Have their current standing orders remain in effect, and
  • Make any new standing order requests.  

Requests for routine NEMT services must be pre-arranged at least 72 hours or 3 days in advance during our reservation hours: Monday – Friday between 7:00 a.m. and 6:00 p.m.  Seventy-two hours or 3 days prior notice includes the day of the call but not the day of the appointment.  For example, call on Monday for an appointment on Thursday as shown in the chart below.  Urgent care and hospital discharges can be requested 24 hours a day / 7 days a week. Medically necessary same day and next day trip requests can be arranged with less than 3 days’ notice.  All trips requested with less than 72 hours prior notice will have to be confirmed with the medical practitioner that the enrollee must be seen in today or tomorrow and that the treatment cannot be delayed.  Otherwise the appointment will have to be rescheduled. 

Three (3) days' prior notice for routine NEMT

Appointment is on:

Contact ModivCare:

Saturday

The Wednesday Before

Sunday

The Thursday Before

Monday

The Friday Before

Tuesday

The Friday Before

Wednesday

The Friday Before

Thursday

The Monday Before

Friday

The Tuesday Before

 

Social workers, case managers or other licensed/certified medical professionals.  If a enrollee requests regularly reoccurring transportation for 3 or more days per week and 3 or more month’s duration, then the Facility Services Department will then contact the social worker or case manager to secure a Standing Order for the enrollee.

ModivCare maintains a staff to resolve any issues when a transportation provider is late or fails to show at the scheduled time. A dedicated Where’s My Ride number 844-678-1104 is available 24 hours a day / 7 days a week to find out the status of the ride and resolve issues. The Where’s My Ride line is also the number to call if the enrollee is ready to be picked up after treatment or if there is an issue with the enrollee’s service, e.g., the driver is late picking up a member.

A copy of the Standing Order Request Form is located on this web site and can be downloaded for your convenience. Alternately, the ModivCare Facility Services Dept. staff can fax the form to you.  You can also request standing order transportation online.

Urgent/same day trips are booked 24 by 7.   All urgent or same day trips will be verified with the physician’s office for medical necessity. If it is a case where the trip request was simply not called in timely, then in those cases the appointment should be rescheduled so that transportation can be booked with 72 hours or 3 days’ prior notice.

An appointment to the doctor deemed urgent by the doctor.

Yes it is.  There is a separate number, which is answered 24 hours a day / 7 days a week to call in a hospital discharge for a Long Island Medicaid enrollee: 844-678-1107.  Medicaid enrollees cannot call in a hospital discharge request.  Only discharge planners or other hospital staff can. Hospitals have preferred transportation providers that they have identified to ModivCare so that ModivCare staff will assign the discharge to that preferred transportation provider.  This assures the pick-up will occur as soon as reasonably possible.  Hospitals should make every effort to keep their list of preferred transportation providers as up to date as possible.

Emergency ambulance trips are not arranged through ModivCare. If an emergency ambulance trip is needed, 911 should be called.

Sudden life threatening medical situations, significant trauma, comas, shock, uncontrolled bleeding, respiratory distress, poisoning, drug overdose and any situation where immediate medical relief or treatment is necessary.

Those trips are booked using the same process that’s used with other trips, and will be authorized provided the service is Medicaid-covered and no closer, comparable medical practitioner is available.

No.  The facility should continue to work with the transportation provider that has been transporting the individual.  If the individual becomes eligible, or again becomes eligible, then ModivCare can retroactively enter the trips back to the date when eligibility is affirmed (up to 30 days prior).  In that case the transportation provider is able, or is again able, to attest to the trips and receive payment.  However, if the transportation provider has been transporting the individual at the request of the facility and the individual does not become eligible or eligible again, then the transportation provider is likely to request payment from the facility.

Yes but only for dialysis patients who are Nassau or Suffolk County Medicaid enrollees.

Enrollees who live within ½ mile of their medical practitioner and can walk there should not request non-emergency medical transportation services from ModivCare.  

Otherwise six types of transportation services are available for Long Island Medicaid enrollees:

  1. Public Transit
    • The enrollee lives within ½ mile of a public transit stop
    • The medical facility is within ½ mile of a public transit stop
    • The enrollee can walk ½ mile blocks
    • The enrollee understands common signs and directions
  2. Livery (ambulatory transport)*
    • The enrollee can walk unassisted from the doorway to the curb and board the vehicle
  3. Ambulette –Ambulatory*
    • The enrollee can walk but is completely unable to walk unassisted and unsupervised to the vehicle, board the vehicle and then walk from the vehicle to the facility entrance unassisted and unsupervised
  4. Wheelchair (ambulette wheelchair)*
    • The enrollee uses a wheelchair and requires a lift-equipped or roll-up wheelchair van and the assistance of trained personnel
  5. Stretcher*
    • The enrollee cannot walk, is confined to bed, cannot sit up or sit in a wheelchair and does not require medical attention during transport.
  6. Non-emergency Ambulance*
    • The enrollee cannot walk, is confined to bed, cannot sit up or sit in a wheelchair and requires medical attention and/or monitoring during transport.

*Note: Medical practitioners must verify the enrollee requires this level of service by submitting a Verification of Medicaid Transportation Abilities MAP 2015 Form.

No. Anyone aged 16 years or younger is required to be accompanied by a parent, foster parent, caretaker or legal guardian.

It is regularly reoccurring transportation for those enrollees who need regularly reoccurring transport to the same facility at the same time on the same day or days.  Facilities fill out and fax in the Standing Order Request Form that’s available on this website, or make their request online. 

The Standing Order Request Form should be faxed to the ModivCare Facility Services Dept. at:

855-848-8640

Call the Facility Services Dept. at 844-678-1106 or fax in updated information do it online.

If a request for NEMT falls under one or more of the denial criteria listed below, then ModivCare must deny the request:

  • The Enrollee is not eligible for NEMT Services on the date of service.
  • The Enrollee does not have a medical need that requires NEMT Services.
  • The requested mode of transportation service is not the most appropriate least costly mode, e.g., requesting ambulette-ambulatory transport for an enrollee who can utilize mass transit or livery transportation.
  • The medical service for which NEMT Service is requested is not a covered medical service.
  • The enrollee has access to available transportation.
  • Transportation to the medical service for which NEMT service is requested is covered under another program.
  • The trip was not requested timely and the request cannot be accommodated because of this.
  • Additional documentation was requested and was not received timely.
  • The Enrollee refuses the appropriate mode of transportation.
  • The Enrollee refuses the NEMT provider assigned to the trip and another appropriate NEMT provider is not available.
  • The Enrollee refuses to cooperate in determining status of Medicaid eligibility.
  • The Enrollee exhibits uncooperative behavior or misuses/abuses NEMT services.

The Enrollee is consistently not ready to board NEMT transport ten (10) minutes after the scheduled pick up time. 

Yes as long as the medical service is covered by Medicaid and the medical practitioner is the closest, comparable provider of the covered service.

NEMT will be authorized for transporting an enrollee to the closest, comparable medical provider. If the enrollee has been referred to a facility/physician outside the CMMA, the referring physician must submit a Form 2020 Request for Transportation Outside the Common Medical Marketing Area for review to determine whether transportation can be authorized.

Yes, only these MCO and HARP Plan Codes are Handled:

HARP & MCO Plan Name

MCO Code

HARP Code

Affinity Health Plan, Inc.

82

AF

Health Insurance Plan of Greater New York, Inc.

(Emblem Health)

HY

HT

HI

Healthfirst PHSP, Inc.

SF

HF

HealthPlus, LLC

AMERIGROUP New York, LLC (Empire BCBS)

KP

AA

New York State Catholic Health Plan, Inc.

(dba Fidelis Care New York)

SP

NC

UnitedHealthcare of New York, Inc.

MO

UC

Neighborhood Health Providers, Inc.

NP

(N/A)

WellCare of New York, Inc.

WC

(N/A)

Call ModivCare we will locate a provider with the correct equipment to transport your patient.  Since this may require more time to locate a provider with the proper equipment, please call us with as much advance notice as possible.

ModivCare will provide transport for the enrollee to the closest, comparable medical practitioner within the CMMA.  If that is your program, then yes.  If that is not your program, then no.  However, the enrollee does retain the option of continuing to come to you.

It would not be considered a covered service because for Diagnosis Related Group patients hospital-to-hospital transport is not covered unless the enrollee is first discharged.

Non-emergency transportation is not covered for taking day habilitation patients to and from the day habilitation site.

If the program is a covered service and is not receiving funding for transporting enrollees to and from the program then you can contact ModivCare to arrange transportation for the enrollees.  At that time please identify the Medicaid-enrolled transportation provider that you wish to continue to transport your patients.

ModivCare schedules but does not pay for trips.  If the trip to the pharmacy has been pre-authorized by ModivCare, then the transportation provider should be able to bill the State of New York for the trip, and get paid.

ModivCare schedules but does not pay for trips.  However, the state fee schedule for transportation provider permits payment of tolls.